Intravenous thrombolytic treatment in acute ischemic stroke

OBJECTIVE: Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. Diagnosis is not easy at initial presentation.
METHODS: All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Systemic inflammatory diseases, inherited and acquired coagulation disorders are frequent causes, although in up to 30% of cases no underlying cause can be identified.
RESULTS: The oral contraceptive pills appears to be an important additional risk factor. The spectrum of clinical presentations ranges from headache with papil oedema to focal deficit, seizures and coma.
CONCLUSION: Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. Intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis.

OBJECTIVE: The metabolic requirement that necessary for the function of neurons is provided by increase of regional cerebral blood flow. The most frequently, visual stimulation is used for measurement of reactivity.
METHODS: In the present study, we assessed the change of blood flow velocities during simple and complex stimulation at posterior cerebral arteries coupling to neuronal activity at occipital cortex.
RESULTS: The 12 healthy individual were included study. The blood flow velocity changes acquired by TCD to complex visual stimulations (44,8±13,3 cm/s) were significantly higher than those of simple visual stimulation (30,0±10,3 cm/s)(p<0,001).
CONCLUSION: Transcranial Doppler Sonography is noninvasive and low-priced cerebral hemodynamic assessment method, and gives information about cerebral perfusion with recording blood flow velocities of cerebral arteries.

One of the rare cause of ischemic and/or hemorrhagic lesions in central nervous system is systemic vasculitis. Churg-Strauss Syndrome (CSS) is a systemic vasculitis which can involve central nervous system. In this report, CSS which is a rare cause of stroke was presented by means of literature in a case who had cerebral ischemic and hemorrhagic lesions.

Arteriopathy, a late complication of radiotherapy, is recognized as an important cause of cerebrovascular disease in patients treated with radiotherapy, especially for head and neck cancers. For this reason, determining risk factors for cerebrovascular disease and taking preventive measures may help at least slowing the atherosclerotic process in patients who should undergo radiotherapy.

Nowadays, it is required to consider complications of AIDS because of increasing ratio of the illness. Frequently these complications may be cardiologic and cerebral. In cerebral arteritis, vessel walls thickening, stenosis and occlusion are observed and these complications lead to cerabral ischemia and infarct.
Stroke mechanism of cases with HIV infection depends on vasculitis and hypercoagulability. Two cases were presented.
Case 1: A 48 year old male was investigated with left hemiparesis, hypoesthesia and agitation symptoms which were occured acutely 15 days ago.There were findings regarding subacute ischemia in right frontal and temporal areas on cranial MRI. In this case which was considered to be in vasculitic process, homocysteine was also increased besides presence of anti-dsDNA, ANA, HIV. Second day of hospitalization, his orientation was deteriorated and agitation increased. On the sixth day he died because of hyperthermia, diarrhea and insufficiency of respiration.
Case 2: The second case was a 36 year old male. Transient ischemic attack has occured twice in this case. In his examination there were lethargy, agitation, left hemiparesis, motor aphasia. His clinical condition improved in six hours. In his medical history there is frequent fever, weight loss and skin eruption. There wasn’t any pathology in this case except for positive HIV, pancytopenia, liver enzymes elevation and cranial MRI. Carotis-vertebral doppler and EEG investigations were normal.